Provider Demographics
NPI:1396727467
Name:CRITCHFIELD, BYRON TODD (PT)
Entity type:Individual
Prefix:MR
First Name:BYRON
Middle Name:TODD
Last Name:CRITCHFIELD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4108 BIG SUR BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-6704
Mailing Address - Country:US
Mailing Address - Phone:573-446-0524
Mailing Address - Fax:
Practice Address - Street 1:520 N STURGEON ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY CITY
Practice Address - State:MO
Practice Address - Zip Code:63361-1829
Practice Address - Country:US
Practice Address - Phone:573-564-5222
Practice Address - Fax:573-564-8241
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO104230225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist